This systematic review examines energy-based treatments of the vagina for postmenopausal vaginal symptoms.
We performed a systematic review, from the end date of our previous review – April 2017 to April 2020, searching Medline, Embase and Scopus.
Inclusion criteria were all randomized studies, prospective studies >10 cases, and retrospective studies with >20 cases published in English or French that assessed change of postmenopausal vaginal symptoms and/or sexual function in women following energy-based vaginal treatments. Meta-analyses were performed on randomized data.
Of 989 results retrieved, 3 randomized studies, 16 prospective studies and 7 retrospective studies were included in the review, representing data from 2678 participants. Pooled data from 3 RCTs show no difference between vaginal laser and topical hormonal treatments for change in vaginal symptoms (-0.14, 95% CI -1.07 to 0.80) or sexual function scores (2.22, 95% CI -0.56 to 5.00). Furthermore, no difference between vaginal laser, topical hormone and lubricant was demonstrated in sexual function (p=.577). Similar to our previous review, non-randomized data supports energy-based treatments improving vaginal symptoms, sexual function and clinician-reported outcomes. No severe adverse events are reported in included studies. Significant heterogeneity of data arising from differing measures and reported outcomes continues to be an issue, with data remaining low quality, with high risk of bias and no double-blind or placebo controlled randomized trials yet reported, although 1 has now completed recruitment.
There are 3 randomized trials comparing energy-based systems to hormonal treatment, with no clinical difference in these 2 approaches. Whilst prospective data continue to show promising outcomes, without strong evidence from well-powered, double-blind placebo-controlled trials to determine efficacy of treatment compared to placebo, the use of energy-based treatments should continue to be undertaken in research studies only, with high quality studies free from bias essential. PROSPERO ID number: 178346.

Copyright © 2020. Published by Elsevier Inc.